%0 Journal Article
%T Trends in adverse maternal outcomes during childbirth: a population-based study of severe maternal morbidity
%A Christine L Roberts
%A Jane B Ford
%A Charles S Algert
%A Jane C Bell
%A Judy M Simpson
%A Jonathan M Morris
%J BMC Pregnancy and Childbirth
%D 2009
%I BioMed Central
%R 10.1186/1471-2393-9-7
%X We applied the MMOI to the linked birth-hospital discharge records for all women who gave birth in New South Wales, Australia from 1999 to 2004 and determined rates of severe adverse maternal outcomes. We used frequency distributions and contingency table analyses to examine the association between adverse outcomes and maternal, pregnancy and birth characteristics, among all women and among only those with PPH. Using logistic regression, we modelled the effects of these characteristics on adverse maternal outcomes. The impact of adverse outcomes on duration of hospital admission was also examined.Of 500,603 women with linked birth and hospital records, 6242 (12.5 per 1,000) suffered an adverse outcome, including 22 who died. The rate of adverse maternal outcomes increased from 11.5 in 1999 to 13.8 per 1000 deliveries in 2004, an annual increase of 3.8% (95%CI 2.3¨C5.3%). This increase occurred almost entirely among women with a PPH. Changes in pregnancy and birth factors during the study period did not account for increases in adverse outcomes either overall, or among the subgroup of women with PPH. Among women with severe adverse outcomes there was a 12% decrease in hospital days over the study period, whereas women with no severe adverse outcome occupied 23% fewer hospital days in 2004 than in 1999.Severe adverse maternal outcomes associated with childbirth have increased in Australia and the increase was entirely among women who experienced a PPH. Reducing or stabilising PPH rates would halt the increase in adverse maternal outcomes.Maternal deaths in childbirth have declined in high-income countries such that they are now rare occurrences (<10/100,000 livebirths) [1-3]. As mortality has traditionally been used as an indicator of the quality of health care, severe maternal morbidity has been suggested as a better indicator of the quality of maternity care [4-10]. Obstetric haemorrhage is the single most important cause of both maternal mortality and severe morbidi
%U http://www.biomedcentral.com/1471-2393/9/7